Myelomalacia and Intracranial Pressure

Introduction to Myelomalacia

Myelomalacia does not necessarily imply increased intracranial pressure (ICP), as these are distinct pathological processes affecting different parts of the central nervous system, according to the American College of Physicians 1

Patients with suspected increased ICP should be evaluated with appropriate neuroimaging and potentially invasive ICP monitoring depending on clinical presentation, as recommended by the American Heart Association 2
Neurophysiological monitoring such as EEG, BAEPs, and SSEPs can complement ICP monitoring by establishing the neurological relevance of increased ICP, but these are separate from the evaluation of myelomalacia, as suggested by the European Association for the Study of the Liver 3
Treatment of increased ICP follows a stepwise approach, beginning with simple measures like head positioning and progressing to more aggressive interventions as clinically indicated, according to the American College of Physicians 1
First-tier interventions for increased ICP include head of bed elevation to 20-30°, sedation, analgesia, and maintaining adequate cerebral perfusion pressure ≥60 mmHg, as recommended by the American College of Physicians 1

Increased ICP is often associated with findings such as ventricular effacement, midline shift, or cerebral edema on cranial imaging, as reported by the American Heart Association 2
The presence of papilledema on funduscopic examination is a key indicator of increased ICP but would not be expected with isolated myelomalacia, according to the American Academy of Ophthalmology 4